PATIENT-ORIENTED MEDICINE: POEMs illustrate the extent of the evolution of clinical practice

 POEMs (Patient Oriented Evidence That Matters) are studies that address a relevant clinical question, demonstrate improved patient-oriented outcomes, and have the potential to change clinical practice. This report, featured in the Annals of Family Medicine, identifies POEMs in each of the past 20 years that have driven the most major and lasting change in medical practice.

POEMs (Patient Oriented Evidence That Matters) are studies that address a relevant clinical question, demonstrate improved patient-oriented outcomes, and have the potential to change clinical practice. This report, featured in the Annals of Family Medicine, identifies POEMs in each of the past 20 years that have driven the most major and lasting change in medical practice.

 

These POEMs (See list on table below) have all been at the origin of new effective interventions (eg beta-blockers in heart failure or a longer delay between each screening smear in women) or abandonment of practices that have been shown to be ineffective (e.g. intensive glycemic control in patients with type 2 diabetes or even aggressive treatment of low-grade prostate cancer).

 

These POEMs illustrate the extent of the changes in practice that have taken place in primary care in recent years and the need for general practitioners to be able to “follow” the medical literature.

 

Ces POEM (Voir liste sur tableau ci-dessous) ont tous été à l’origine de nouvelles interventions efficaces (ex : les bêtabloquants dans l’insuffisance cardiaque ou un délai plus long entre chaque frottis de dépistage chez les femmes) ou de l’abandon de pratiques démontrées comme inefficaces (ex :  contrôle intensif de la glycémie chez les patients atteints de diabète de type 2 ou encore traitement agressif du cancer de la prostate de bas grade).

 

Ces POEM illustrent l'ampleur des changements de pratique intervenus ces dernières années dans les soins primaires et la nécessité pour les médecins généralistes de pouvoir « suivre » la littérature médicale.

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ETP: Patients would like to know a little more about their medications

 Clinical guidelines are good because "it helps to increase the proper use of medicines", but their impact on patients is not always taken into account, concludes this study from the University of Kent (Canterbury, UK) . The study reveals, in the journal Health and Social Care in the community, that patients want more information about their medications and also want to have a say in the products prescribed.

 

Professor Janet Krska, an expert in pharmacology, conducts her research on the heaviness of long-term drug use in patients. With her team and for this study, she has developed a questionnaire, the “Living with Medicines Questionnaire” or LMQ, which makes it possible to assess the impact of treatments on quality of life. The questionnaire covers 8 themes, the relationship with the attending physician, the main interferences of the treatments with daily life, the lack of therapeutic efficacy, the side and undesirable effects, the general observations, the cost and the lack of autonomy. Analysis of data from 684 respondents shows that:

 

• P atients who take the greatest number of drugs who are also those who experience the most adverse effects are also those who would like to be better informed ;
• Surprisingly, older patients rate the use of regular medications less burdensome than younger patients, even though they use more medications;
• more than a quarter of the users questioned wanted to obtain more information about their medicines and to have more say in the medicines prescribed;
• a similar proportion are concerned about drug prices;
• over 50% are concerned about long-term side effects;
• about 11% say they are not satisfied with the effectiveness of their treatment;
• between 10 and 16% regret that their treatment interferes with certain aspects of their daily life;
• 30% even declare that “their life revolves around drugs”;
• 16% regret that their doctor did not listen to their opinion on medication;
• 11% say their doctor doesn't take concerns about their side effects seriously.

 

Clinical guidelines are a good thing, concludes Professor Krska, but there is a huge need for education of patients and health professionals. We note indeed and again , a lack of listening to the doctor when prescribing.

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DOCTOR-PATIENT DIALOGUE: It eases pain and prevents depression

 Researchers at the University of Aarhus (Denmark) call this “Talk therapy” and they show how crucial this dialogue with the general practitioner is after the death of a parent or loved one. A full-fledged “prevention” act of the risk of suicide and/or psychiatric disorders which is part of primary care missions, in the same way as the prescription of antidepressant treatments.

 

Losing a family member or loved one is psychologically extremely painful and generates the highest level of distress and stress. Painful enough to have suicidal thoughts or develop other psychiatric disorders. This broad analysis is conducted on data from 207,000 Danes, aged over 18 who lost a child, spouse, sibling or parent during the period 1996-2013. Among these participants, 4,584 patients (2.2%) were affected by an effect such as suicide, self-harm and admission to a psychiatric ward. Data analysis reveals the benefits of talk therapy:

• patients who benefit from it are less likely to develop TS and other psychological disorders
• in patients who received antidepressant treatment within 6 months of bereavement, 9.1% experienced severe effects of their bereavement, in patients who received talk therapy, this rate was reduced to 3.2;
• the overall risk of serious psychiatric disorders during the grieving process would be reduced by 1.7% if the patient receives talk therapy.

 

 

A result that will encourage general practitioners to reserve drug treatment for the most severely depressed patients? However, patients "deprived" of antidepressants could then incur an even higher risk? The researchers are nevertheless convinced, in view of their results, that an early "talk therapy" in response to these grieving patients can prevent, on its own, at least in some patients, the risk of severe psychiatric events.

Unfortunately, the study does not say whether general practitioners are sufficiently prepared and have, in practice, the availability in time for this intervention.

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